It is really important to remember that the role of the veterinary nurse when dealing with any exotic patient is crucial to the well-being and recovery of that animal. Many details about the patient are often noted by unobtrusive observation and patience, which is when the nursing becomes invaluable. Observation should include any aspect of the patient's behaviour, nutritional status, development of any clinical signs and the positive aspects of recovery.

The veterinary nurse should be encouraged to speak to the patient's owner, ideally at consultation. They should know how the patient is kept by the owner, particularly any normal interaction, husbandry, behaviours, feeding habits, faecal output and changes that have occurred. Birds are very adept at hiding clinical symptoms for long periods of time and often little things that the owner hasn't thought were relevant can act as a guideline to assessing the state of the patient.

Hospitalisation

Ideally a separate ward should be used when hospitalising birds so they are not in constant fear of other patients such as dogs or cats. If this is not possible then have the bird cages at one end of the ward where the occupants cannot see other animals. Perching birds should have their cage between human waist and shoulder level, and ground-dwelling species lower down. Nervous birds will feel a lot more comfortable if there is only one side of the cage open to the room; a towel or blanket can be placed over any open sides.

Any avian ward should preferably have an incubator which can have temperature and humidity controlled, and also be able to have a source of oxygen attached for any emergency patients that come in.

By law the minimum cage requirements allow the bird to stretch their wings in a full flapping motion and, if perched, to enable the tail feathers to be off the floor, but this must be recognised as the absolute minimum.

Cages to avoid include:

 Tall, narrow cages

 Plastic coated or galvanised metal wire

 Wooden cages

The cage should include:

 Room to flap, fly freely, climb, perch and play

 Doors that are only opened from the outside, but also big enough for access when handling but not escape

 Furniture that is not harmful and also not too cluttered

 Means for easy cleaning

 Hide boxes or shelters

To ensure environmental enrichment and relief from boredom birds should have access to:

 Bathing water

 Natural foods and branches to nibble on

 Social interaction

 Toys and games for mental stimulation

Perches

Wooden perches are ideal, of a variety of sizes. This ensures exercising of the feet and reduction of any chance of pressure sores. Use natural branches of trees that are not toxic to the bird, for example apple, ash, beech, birch, citrus, elm, hazelnut, hawthorn, pine, or willow branches.

Perches should not be covered in sandpaper as this does not help keep the nails short and adds to problems with sore feet.

Perches should be placed around the cage not on top of each other as the lower perches become covered in excrement and waste food. They should be high enough so tail feathers are not in contact with the floor, particularly for birds of prey used for flying. Tail guards can be placed to save feather condition, a piece of old radiography film placed either side of the tail can be secured with staples or suture to prevent it slipping.

Many birds of prey are given blocks or bow perches to stand on, and these may be covered with Astroturf.

Bird Comfort

Cages or incubators used for sick and debilitated birds should ideally have their own heat and humidity source and if possible a light. A means of delivering supplemental oxygen is also necessary. For most of these patients standing for any period or being able to perch may be impossible, so using soft rolled towels or cushioned bedding like Vetbed® means the bird can be propped up to enable eating and drinking, and also reduces the likelihood of pressure sores developing on the feet or keel bone. Lighting can be controlled to be slightly dimmed to reduce stress levels whilst still ensuring enough light to stimulate the natural feeding habits.

Food and Water Bowls

The type of bowls used depends on the species. For larger parrots plastic bowls are not ideal as they chew them, whereas ceramic bowls are easily broken when played with; for these species stainless steel bowls are preferable.

Bowls that can be attached to the cage and filled and cleaned without need to open the cage are very useful as it reduces the possibility of escape and any added stress.

When filling the bowls don't fill them to the top as most birds sift through food causing excess wastage. Some birds like to dunk food in their water so two water bowls in the cage can ensure fresh water for longer.

Cleaning

The base of the cage should be covered with a material that is easy to clean or remove, and the best option is newspaper. Sawdust and wood chippings can be eaten causing crop irritation and impaction. Newspaper allows easy assessment of the amount, colour and consistency of faeces and urates, and the amount of food eaten and discarded.

Handling

Many birds will view the handler as a potential threat due to size, approach and handling skills. This can initiate several different behavioural responses i.e.:

 Escape

 Freezing in fear

 Attacking

If you have a good understanding of these responses it will lead to better handling with calmer and easier restraint.

Key Points for Handling

 Keep the patient, handler and environment as calm as possible to reduce any potential risk of accidental injury and further decline of the patient

 Handle the patient correctly and competently, ensuring that the wings, feet, talons and beak are under control

 Remember there is a heightened level of stress due to hospitalisation

 Before you start have everything ready for handling, treatment and procedures so handling is achieved as quickly as possible

 Beware approaching from above or towering over the patient, avoid casting shadows over the cage, and place the cage if possible at waist height before handling

 Approach the patient quietly, slowly and deliberately and if needed speak in a quiet calm reassuring voice

 Dim the lights, lock doors and windows to ensure a safe and secure handling area

 Always handle with confidence as it helps the patient feel more relaxed and less likely to panic or struggle and feel insecure

Administration of Medication

When any treatment is being administered it is important to ensure:

 The correct dose of drug

 The correct drug strength (mg/ml) or tablet chosen

 That the drug calculation is checked and dispensed correctly

 The correct route of administration

Calculation of Drug Dosages

E = (W/1000) 0.75 x D
E = dose of drug in mg according to body weight (W)
W = Weight of bird in grams
D = dose of drug for larger vertebrate in mg/kg.
(Taken from BSAVA Manual of Exotic Pets)

Routes of Administration

 Subcutaneous--axilla, lateral flank, interscapular area

 Intramuscular--pectoral muscles

 Intravenous--jugular, brachial or medial metatarsal veins

 Intraosseous--distal ulna, proximal tibia, avoiding the pneumatic bones

 Oral--by crop tube or tablet form

 Nebulisation--aerosol treatment for respiratory disease

The choice of route depends on the medication given but also the size of the patient.

Blood Sampling

 Jugular vein--the right side is larger

 Ulnar/brachial vein--runs cranially over the humerus

 Medial metatarsal vein--used largely in waterfowl, runs down the medial aspect of the leg

Diets and Force Feeding

It is essential to have a good understanding of normal diets. Unfortunately many owners do not feed an adequate diet and a lot of diseases are diet related. Birds have a higher metabolic rate than mammals, so it is important to ensure adequate amounts of food are available and that enough is eaten to supply metabolic demands.

Fasting prior to anaesthesia is for shorter periods of time compared to mammals, as fasting depletes the birds' glycogen reserves within the liver. Glycogen is needed to detoxify and eliminate toxic levels of medications so therefore can be life threatening if reduced. Birds below 100 g should only be starved for 1 hour, whereas larger parrots can be starved for 3-6 hours. It should be remembered though that birds should not be anaesthetised with a full crop, especially birds of prey.

Most birds eat in daylight, so it is important to ensure 12 hours of light in order that they can fulfill their nutritional needs. Baby birds will generally eat every 1-2 hours or whenever their crop is empty.

Crop feeding is easily carried out by having the bird restrained with the head stabilised. A gag can then be placed into the beak to stop any damage with the crop tube but also for visualisation. The crop tube is passed from the bird's left to the right over the top of the tongue down into the oesophagus. Before giving the food feel the crop area for the end of the tube to ensure it is in the right place, then gently give the food looking for any coming back into the mouth. If this occurs before all the food is given, stop and leave feeding until later.

Summary

There is a large range of avian patients now being seen in practices ranging from cage birds to birds of prey and wildlife. This means that the veterinary nurse needs to gain an increasing amount of knowledge to cover all the species that may be seen, especially of handling skills, feeding regimes, husbandry and different approaches to care. It is important to be able to tailor techniques to patients which are used to human contact and to wildlife that is highly stressed by our presence. Gaining this knowledge will enhance our patients' nursing care and allow for better outcomes.